| NPI | 1972224491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2348461) |
| Additional Taxonomies | 163WR0400X Registered Nurse, Rehabilitation (Licence: MA RN2348461) |
| Enumeration Date | 2022-09-05 |
| Last Update Date | 2022-11-22 |